Covid ‘war zone’ has left medical interns tired and undertrained: study

When Amanda joined one of SA’s large public hospitals as a medical intern in 2020, she had no idea she would soon be working in a “war zone” as the Covid pandemic took hold.

“I certified more people (dead) than I thought was possible,” she said. “I thought it would take me a couple of years as a doctor before I could certify so many people.”

The 29-year-old, who completed her internship in December, said working as a young doctor during the pandemic left her anxious and burnt out.

But she also feels undertrained, having spent most of her time on the Covid front line instead of getting broad experience.

“At the hospital where I worked it was not even open for discussion whether or not you would be working in a Covid unit,” she said.

As inexperienced as I was, sometimes I would be the only doctor in charge of the night shift. I had to make the most difficult decisions on which patients to save.

—  Amanda, a second-year intern

“I worked in a Covid intensive care unit where you deal with patients who are ventilated and on oxygen machines. As a first-year intern that experience was very daunting.

“As inexperienced as I was, sometimes I would be the only doctor in charge of the night shift. I had to make the most difficult decisions on which patients to save and who not to give treatment to.”

Research by the University of KwaZulu-Natal exploring medical interns’ experiences during the first wave of Covid found that, while these young doctors appreciated working in a high-demand environment, they also experienced stress.

Some of the concerns interns raised included decreased exposure to patients, pathology and training, as many patients stayed at home due to Covid fears. Fewer patients meant fewer procedures, no training programmes and no academic classes for interns.

Interns also pointed out systematic challenges, such as poor supervision by senior doctors who they say emotionally abused them and neglected giving feedback and debriefings.

Many said they still required experience they missed out on by being placed in Covid units.

“Interns are supposed to be rotated every three months, but in our case all of that went out of the window,” said Amanda.

“I personally feel less confident in some disciplines such as surgery and paediatrics, as I spent most of my time in Covid-19 units and very little time in other departments.

Another threat was the safety concerns many interns expressed about being infected by Covid-19. These concerns extended to their families, particularly the elderly and their partners.

“How are we supposed to get all the training we need when we are continuously praying we don’t die or go home and spread the disease?” said a second-year intern who took part in the study.

The interns also reported unprofessional behaviour from their supervisors and senior medical staff, which they said hindered their learning and increased their fears.

“Senior medical staff have a terrible bedside manner, which is now exaggerated with the pandemic,” said a second-year intern.

“The ever present threat of being dismissed if one refused to go to the Covid-19 unit to be abused hinders one’s willingness to learn substantially,” said another.

However, some interns said Covid helped them to develop coping skills, resilience,  adaptability, flexibility and independence, and exposed them to crisis management.

“I’m just an all-around badass taking it all in my stride,” a second-year intern told researchers, and a first-year added: “I am always around looking for ways to get involved.”

In the study published in the African Journal of Primary Healthcare and Family Medicine, lead researcher Dr Veena Singaram and colleagues said the pandemic should be used to formalise a curriculum shake-up that ensures holistic skills are part of doctors’ training. 

“The forced usage of burgeoning online training platforms during the pandemic can serve as a model according to which future intern training can be done. This has special relevance in resource-constrained contexts,” they said.

SA Medical Association head Dr Angelique Coetzee said Sama was concerned about how the pandemic had affected interns’ training and was “in consultation with various departments to see how this problem could be solved”.

She said all doctors had taken strain, with many stretched to the limit and struggling to cope with work pressures as well as keeping their families safe. Many were now experiencing post-traumatic stress disorder.